State House Notebook: Pressure’s off House for vote on expansion of MaineCare

The Senate failed to approve MaineCare expansion with a veto-proof majority last week, but that’s not the end of the MaineCare debate or votes.

This week, the House will likely take up the compromise MaineCare expansion plan crafted by Republican Sens. Roger Katz and Tom Saviello. The plan would add managed care to the state’s MaineCare system in an attempt to attract moderate Republican votes and contain costs in a program that often has cost overruns.

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That tack failed, at least in the Senate, as Katz and Saviello were the only Republicans to cross party lines in a 22-13 vote. Republican Gov. Paul LePage is expected to veto the bill when it reaches his desk.

Rep. Richard Farnsworth, D-Portland, and House chairman of the Legislature’s Health and Human Services Committee, said Friday that he’s not optimistic the House will approve the bill with enough Republican votes for an override.

“If it had passed the Senate (with a veto-proof majority), there would have been a lot of pressure in the House, and we may have had a chance,” Farnsworth said. “The pressure’s off now, and there’s not as much pressure for Republicans to vote against their party’s leadership.”

Strangely, the compromise plan is shedding, rather than attracting, Republican votes. Rep. Carol McElwee, R-Caribou, who voted for MaineCare expansion in 2013, has come out publicly against the compromise, saying she doesn’t agree with the managed care component touted by Katz and Saviello. And the Senate lost the support of Sen. Patrick Flood, R-Winthrop, who also voted for the expansion last year.

Maine is among 21 states that have not approved Medicaid expansion under the Affordable Care Act, a key way that the law provides more coverage to the uninsured. The law originally mandated that all states sign onto expansion, but the U.S. Supreme Court ruled in 2012 that the expansion must be optional.

Despite the bill’s glum prospects, Farnsworth said, the House will likely vote on the MaineCare compromise Tuesday.

COMMENT GOES VIRAL, CRITICIZED

Comments made by Rep. Deb Sanderson, R-Chelsea, to the Press Herald went viral on Friday, with the progressive blog site Daily Kos and other liberal sites picking up her statement that not expanding MaineCare will provide an incentive for some to earn more money to qualify for generous subsidies available on the Affordable Care Act’s health insurance exchange, or marketplace.

Sanderson’s comment that “maybe it will incentivize some folks” to pick up extra work was lambasted by the liberal bloggers for – in their view – demonizing the poor.

Sanderson said the Press Herald’s story Thursday was to blame for truncating her comments, because in addition to the “incentivize” statement, she also said something needs to be done to improve health care for those in the lowest-income bracket. Because the added context favorable to low-income Mainers didn’t make it into the newspaper, she said, she became a target of the liberal bloggers.

Readers sent her disparaging emails and phone threats, Sanderson said, after her comments went viral.

Sanderson, who is against expanding MaineCare, said she doesn’t know specifically what else can be done for the uninsured, but solutions should be looked at.

Thursday’s story was about low-income Mainers who fall into an unintended loophole in the Affordable Care Act.

States like Maine that chose not to expand Medicaid leave adults who earn less than 100 percent of the federal poverty level – about $12,000 for a single adult – not only without Medicaid but also effectively shut out of the new health insurance marketplace. That’s because adults need to earn at least about $12,000 to qualify for the subsidies. And those subsidies make health insurance “absolutely affordable,” Sanderson said.

Half to two-thirds of the 70,000 who would be covered by a MaineCare expansion – those who earn between 100 percent and 138 percent of the federal poverty level – can obtain subsidies that reduce premiums to as little as $15 to $20 per month, with additional cost-sharing subsidies further lowering their out-of-pocket costs.

While Sanderson may have been vilified for making the statements, some uninsured Mainers in the lowest income bracket interviewed by the Press Herald said they are making similar calculations, looking for side jobs or adding hours to their workday in order to cross the $12,000 threshold and capture the subsidies.

Sanderson also said some options do currently exist for low-income Mainers without health insurance, including more than 150 free health clinics across the state.

She said Democrats have been downplaying the subsidies during the MaineCare debate, and many pro-expansion protesters, when approached by Republican lawmakers during rallies at the Capitol, were unaware that the subsidies were an option.

But Democrats have made light of the irony that Republicans opposed to the Affordable Care Act are at the same time praising the subsidies that were borne out of the ACA. The subsidies are merely a convenient argument against MaineCare expansion, Democrats say.

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